Shamayal Mandokhel, Mohammed Ahmed, Attiqueur Rehman, Binav Shreshta.
Haematological changes in Malaria in Balochistan.
Pak J Med Health Sci Jan ;6(3):601-4.

Patients and methods: It was a descriptive study, carried out in department of Medicine BMC hospital Quetta for a period of 4 months (July to October). All the patients, above 12 year of age who are smear positive for falciparum malaria admitted in BMC hospital Quetta was included in this study. Following patients were excluded from this study: those suffering from non-falciparum malaria; those suffering from congenital hemolytic anemia and bleeding disorders. After inclusion a detailed history and focused clinical examination pertinent investigations were done which included complete blood picture, peripheral smear, platelet count, reticulocyte count, urine, prothrombin time, partial thromboplastin time. Results: Out of 100 patients 58% was male and 42% were female with the ratio of (1.38:1). Anemia was present in 34 patients (female to male ratio 1.42:1) showing the female predominance. Mean age of anemic patients was 21.75 years. Range of hemoglobin was (4.2-10.5g/dl). Hemoglobin less than 8 was found in 15 patients (44.11%), with male to female ratio (1:2.25). Anemia was predominately hemolytic origin as detected by raised indirect bilirubin and increases in reticulocyte count and this was found in 94% of the total anemic patients. Type of anemia was normocytic normochromic (93%) as shown by peripheral smear and blood indices; however in 7 patient’s type was microcytic hypochromic. Thrombocytopenia was found in 44 cases with a female to male ratio (1.44:1), range observed to be 20,000-38,7400/mm3. Platelet count less than 50000/mm was significantly found in 15 patients with a female predominance. Normal leukocyte count was noted in majority of patients (n=68), however leukopenia count less than 5000/mm3 was found in 29 % of patients with female to male ratio (1.9:1). Leukocytosis was uncommon, found in 3 % of patients. Prothrombin time and APTT were raised in 17% of total patients, with range of 12.1sec to38.5 sec and 23.2 to74 sec respectively. PT>32.5 sec and APTT> 64 sec were noted in 4 patients. FDP was done only in those patients who shows raised PT and APTT, and was found to be raised significantly in 4 % of patients with male to female ratio (1:1). Conclusion: Complete blood Picture is easy to done, informative and helpful to pick the patients with severe malaria, so that early aggressive treatment should be done in time. Moreover, clinicians should be aware to the possible hematological complications of falciparum malaria and be ready to manage the patient with blood transfusion and with fresh frozen plasma.

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